Kakaire A. Kirunda
23 August 2008
opinion
Two years ago, Uganda and other 156 UN member states boldly committed to a plan to ensure that everyone of its citizens would have access to services designed to prevent the spread of the HIV virus by 2010. But now, that goal appears beyond our reach - and, indeed, beyond the reach of much of the developing world.
According to the Vice Chairperson of the Parliamentary Committee on Social Services, Dr Chris Baryomunsi, also a member of the committee on HIV/Aids, there are challenges that each country faces.
"That is why between now and 2010 we may not be able to attain universal access. What we should do as a country is to define our universal access our own way to set realistic targets," he said in an interview.
An estimated 1 million adults and 110,000 children are said to be living with HIV the human immunodeficiency virus which causes Aids.
With an estimated 360 new infections everyday, the country is no longer being cited as the HIV/Aids success story. Rather, the mention of Uganda in international HIV/Aids circles is followed by a country that is now having its HIV prevalence rising again.
From a high prevalence of 18 per cent of the population having HIV in the early 1990s, to a reduced 5 per cent by 2000, it now stands at an estimated 6.4 per cent of the adult population. This clearly shows that prevention efforts are not working as they should.
Scientists now argue that the pandemic will never be defeated without effective prevention. Not mere prevention, but combined prevention. This approach would see behavioural change such as reducing concurrent relationships and using condoms.
Similarly, biomedical strategies such as circumcision and the prevention of mother-to-child transmission make part of this. There would also be treatment of HIV, other viruses and sexually transmitted infections. And issues of social justice and human rights are encompassed in this multi-pronged response.
However, this is not effective. An editorial in a special edition of the prestigious Lancet Medical Journal with a special series on prevention (with several citations from Uganda) that was launched at AIDS 2008 in Mexico City concluded that from the very beginning of the global response to Aids, prevention has been marginalised. It says treatment has dominated. And this imbalance, it was argued, is largely responsible for the new infections each year.
It emerged this March that the epidemic had squared off at 132,000 infections each year. Yet the population continues to grow, meaning that more people are getting infected.
Uganda admits in her latest 2010 progress report to the United Nations General Assembly [submitted January 2008] that the prevention communication that brought about the turn around in prevalence in the 1990s is not compelling anymore and focus now is more on the availability of ARVs.
ARVs make HIV seem a lot less threatening. De-stigmatisation appears to have reduced a powerful incentive to follow prevention measures. And social forces, from modern entertainment to economic development may be encouraging unsafe behaviour and overwhelming prevention messages.
The progress report says there is therefore a need to re-focus the prevention strategies to address the current trends of the prevalence.
The roadmap to universal access to HIV prevention of the Uganda HIV/Aids Partnership Committee (UHPC) overseen by the Uganda Aids Commission also points a picture at faltering prevention efforts. The roadmap offers a gloom picture on the scope, intensity and uptake of key interventions aimed at prevention. This makes achieving universal access next to impossible.
"The number of actors involved in IEC [information, education and communication] for behaviour change in the context of HIV/Aids prevention has decreased over the years. Currently only 17 percent of agencies implementing HIV/Aids interventions have a component for community sensitisation and education for prevention, a fall from 78 per cent in 1997," according to the road map document.
It is further stated that support to relevant institutions and structures dealing with life-skills training especially for the out of school young people has not received priority attention. Brought to light as well is the worrying trend showing that despite the high knowledge and awareness levels about the efficiency of condoms, their use in the country has remained markedly low.
Worse still, "it has been difficult to achieve widespread, consistent and correct use in any high risk sexual relationship other than commercial sex and casual sex," states the road map.
Regarding testing, the road map shows that lack of adequate infrastructure, personnel, stock-out of HIV testing kits and reagents have characterised the service. Limited progress in the promotion of couple testing and dealing with discordant couples at service level continues to be in issue.
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